The latest news on omega-3 fats has caused quite an uproar. How is it that, after so many years of hearing about the benefits of this essential fatty acid, we could suddenly see the results turned upside down?

THE OMEGA-3 CONTROVERSY

The controversy stems from a review published in the Sept. 12 edition of the Journal of the American Medical Association, which examined the role of omega-3 fatty acid supplementation on major cardiovascular outcomes. In this review, researchers examined the effects of increasing omega-3 fatty acid intake from either diet or supplements in 20 different studies across 68,680 patients who were tracked for incidents of heart attack, stroke, cardiac death, sudden death and death from all causes (all-cause mortality) for at least a year.

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When the data from all 20 studies were taken together, the researchers were unable to detect a statistically significant difference between those taking omega-3s and those who did not — for any of the aforementioned outcomes. If the results of this review are taken at face value, they suggest omega-3 fatty acids play no role in preventing fatal or non-fatal cardiac events, including heart attack or stroke.

THE REALITY

But is that the whole story? As with all studies, it is important not to jump to any conclusions until you take a detailed look at the study and results. So let’s take a closer look — and ask some important questions — before we collectively relegate our fish oil supplements to the dustbin:

The populations: What type of people were examined in these 20 studies? Mostly, they were of European descent, as well as a large study of Japanese adults. Notably, however, this review pooled together both primary and secondary prevention studies, meaning that some of the studies looked at the impact of omega-3s on the prevention of a first heart attack or stroke (primary prevention), while others focused on the role fish oils play in the prevention of a second cardiac event or death (secondary prevention). The difficulty of lumping these two groups together and drawing conclusions is that patients in secondary prevention studies are often engaged in numerous heart health interventions, ranging from taking blood pressure or cholesterol medications, to making dietary and lifestyle changes, to being monitored by their physician and health care team on a regular basis. The cumulative effect of each of these changes means that it is possible — even likely — that the benefit of fish oils are rendered nearly inconsequential. Ultimately, only four of the 20 studies looked at the role that fish oils play in primary prevention, and none exclusively.

The doses: The American Heart Association recommends we aim for 500 mg of EPA plus DHA (the two types of omega-3 fatty acids that seem to have the most relevance to heart health) per day for general prevention, and 1,000 mg per day for those with established heart conditions. So how did the doses used in the review compare? The average intake was a shade over 1.5 grams of total omega-3 fatty acids per day, of which 0.77 grams (770 mg) came from EPA, and 0.6 grams (600 mg) from DHA. In other words, the average dose was actually quite comparable to what has previously been deemed an appropriate target for omega-3 intake, though there was considerable variation between studies.

The unanswered questions: At least half of the studies took place in the post-statin era; now that these cholesterol-lowering medications are so common in cardiac prevention, have they rendered omega-3 fatty acids irrelevant, especially for secondary prevention? And what of the increasingly important question of genetics? We now have evidence that omega-3 fatty acids do little to lower triglycerides, a type of fat in the bloodstream that is harmful to the heart, in certain individuals. Unfortunately, genetic data was not available to the researchers conducting this review, but it could help explain why the omega-3 supplements showed a clear trend towards being beneficial in this study (for example, omega-3 supplements were associated with a 9% reduction in risk of cardiac death, a 13% decreased risk of sudden death, and an 11% reduced risk of heart attack), but without quite reaching statistical significance.

THE BOTTOM LINE

While no policy changes have yet been made as a result of this study, its results would suggest omega-3 fatty acid supplements may not offer any additional protective benefit for those who have already had a heart attack or stroke and have access to good treatment. For everyone else, the jury is still out. And until we have a better understanding of how our genes ultimately influence whether or not omega-3s work for us, we will likely continue to see conflicting studies such as this.

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